Integrated dual-functional laser-electric optical fiber：A prototype device for urologic surgical procedures

Integrated dual-functional laser-electric optical fiber：A prototype device for urologic surgical procedures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrated dual-functional laser-electric optical fiber：A prototype device for urologic surgical procedures Dongchong SUN, Yutao ZHANG, Likun GAI, Chenglin ZHANG, Yanna WANG, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6213235/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose We introduce an integrated optical fiber that can simultaneously transmit high-power laser energy and conduct electricity for urologic surgical procedures. Methods An integrated dual-functional laser–electric optical fiber was successfully developed based on a widely used medical high-energy optical fiber, modified with electrical components. This fiber can connect with a thulium laser and a bipolar plasma generator simultaneously. Using the fiber, an ex vivo simulation of transurethral vaporization of porcine kidney tissues was conducted in three groups (laser-plasma, laser, and plasma). Tissue removal efficiency was calculated using the weighing method, and tissue thermal damage was assessed by Hematoxylin and Eosin (H&E) staining. One-way analysis of variance (ANOVA) and least significant difference (LSD) test were used for statistical analysis. Results The integrated fiber is compatible with the laser resectoscope. In terms of tissue removal efficiency, the laser-plasma group had the highest [(0.433 ± 0.039) g/min] and the plasma group had the lowest, while there was no significant difference between the laser and plasma groups [(0.141 ± 0.017) vs (0.117 ± 0.052) g/min, p = 0.470]. For thermal damage, there was no significant difference between the laser-plasma and laser groups [(985.484 ± 178.509) vs (957.511 ± 197.375) µm, p = 0.602], but both were significantly higher than those in the plasma group [(499.639 ± 77.992) µm]. Conclusion A prototype of an integrated dual-functional laser-electric optical fiber was successfully developed. Compared with the laser or the plasma energy alone, the combined laser-plasma energy can vaporize kidney tissue more efficiently without additional thermal damage. laser electrosurgery integration vaporization urologic surgical procedures Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Lasers and electricity are commonly used energy sources in urological surgery. Each has its own advantages and disadvantages. Transurethral resection of the prostate (TURP) remains the historical benchmark surgical treatment for benign prostatic hyperplasia (BPH) [ 1 ]. TURP with bipolar plasma offers better durability but higher complication rates for elderly patients with multiple comorbidities compared to laser prostatectomy [ 2 ]. Laser prostatectomy, while advantageous in terms of hemostasis and shorter hospital stays, is less efficient and less cost-effective than TURP [ 3 ]. Consequently, it is challenging for either method to supplant the other. Some urologists have successfully combined the use of a thulium laser with bipolar TURP for the endoscopic treatment of BPH [ 4 ]. However, these methods are applied sequentially rather than truly integrated, making the procedure time-consuming and labor-intensive. To address this issue, we hypothesized that integrating laser and electrical energy into a single device could be a viable solution. Therefore, we attempted to incorporate electrical elements into the optical laser fiber to create a surgical tool capable of simultaneous both laser and electrical vaporization/resection for urologic procedures. Materials and Methods Preparation of the Integrated Laser-Electric Fiber A commercially available high-energy medical optical fiber ( Raykeen, Shanghai, China ), with a diameter of 550 micrometers, and with a stripped outer layer at the distal end, was prepared for integration with the electrical components. The electrical components included a fine metal wire and a tiny stainless-steel tube, which were attached to the bare optical fiber and insulated with a plastic tube. Approximately half of the small stainless-steel tube was exposed near its distal end. The proximal end of the fine metal wire was connected to the output of a bipolar plasma generator. A standard transurethral laser resectoscope ( F26, Raykeen, Shanghai, China ) was used in this experiment. The outer sheath of the resectoscope was connected to a plasma generator to serve as part of the electric circuit. The knob lock of the resectoscope served as the access point for the circuit. The integrated fiber was passed through the fiber channel of the resectoscope and connected both to a thulium laser machine and a bipolar plasma generator. The final form of this new system is illustrated in the schematic diagram in Fig. 1 . Verification of Integrated Laser-Electric Fiber To evaluate the functionality of the integrated fiber, a series of simulated transurethral vaporization tests were conducted. Isotonic saline was maintained at room temperature and served as the irrigation fluid. Commercial fresh porcine kidney tissue was utilized as vaporization target. A continuous thulium laser ( Raykeen, Shanghai, China ) and a bipolar plasma generator ( Olympus, Tokyo, Japan ) were employed in the tests, with energy outputs set at 50 W for the thiulum laser and 100 W/50W (cutting/coagulation mode) for the plasma. The tests were categorized into three groups: laser–plasma, laser, and plasma group. In the laser–plasma group, simultaneous activation of the laser and plasma was achieved by depressing both foot switches concurrently. All surgical procedures were performed by a single urologist to ensure consistency. During vaporization, the speed of the back-and-forth movement and the downward force applied to the kidney tissue were meticulously maintained at consistent levels. Tissue specimens were collected post-vaporization and fixed in 4% formaldehyde solution. Hematoxylin and Eosin staining was subsequently performed on 5-µm-thick sections for histopathological analysis. The extent of thermal damage in the kidney tissue was examined and quantified. Tissue removal efficiency was assessed using a weighing method. The kidney tissue was weighed before and after vaporization, and the duration of each vaporization procedure was recorded. Tissue removal efficiency ( g/min ) was calculated by dividing the change in tissue weight ( grams ) by the vaporization time ( minutes ). Statistical Analysis Online software SPSS Pro (available at https://www.spsspro.com ) was utilized for statistical analyses. Data were presented as mean ± SD. Results were analyzed using one-way analysis of variance (ANOVA) followed by the least significant difference (LSD) test. A p-value of ≤ 0.05 was considered statistically significant. Results Product of the integrated dual-functional laser-electric fiber An integrated dual-functional laser-electric optical fiber was successfully developed as shown in Fig. 2 . An electrically conductive wire was securely attached to the fiber and connected to the built-in metal wire inside the integrated fiber, enabling direct connection with the output of the plasma generator. During surgery, any distal segment of the fiber, including the tiny stainless-steel tube, could be cut off if necessary. Usability and safety During all experiments, especially when the bipolar plasma generator was excited, the body of the resectoscope and electric circuit were inspected with an electric pen, and no instances of electric leakage were detected. The integrated fiber was manipulated similarly to an ordinary optical fiber in transurethral laser operations. When required, the tiny metal tube was easily maneuvered to a virtual bleeding point for hemostasis in coagulation mode. The surgical view remained clear and was not impaired by any part of the integrated fiber, including the stainless-steel tube at the tip of the fiber. The number of air bubbles generated during vaporization was not significant, and the surgical field visibility was not affected. The tiny stainless-steel tube at the integrated fiber tip remained securely in place. When continuously excited under the laser-plasma mode, the stainless-steel tube maintained normal functionality for at least 5 minutes [(5.07 ± 0.34) min]. If substantial self-ablation occurred, the damaged stainless-steel tube could be easily cut off, and the adjacent segment was available for continued use. The vaporization procedures could be seen in the supplemental video ( Supplement 1 ). Tissue removal efficiency Macroscopically, after only one pass of vaporization with the integrated fiber, the vaporized defect caused by the laser-plasma energy was the deepest among the three groups. The tissue removal efficiency of the laser-plasma group was significantly greater than that of the plasma group, which demonstrated the lowest efficiency. No significant difference was observed between the laser group and the plasma group (Fig. 3 ). Thermal damage to the kidney tissue For thermal damage to porcine kidney tissue, the carbonized, coagulated, and denatured layer was easily recognized under the microscope (Fig. 4 ). The degree of thermal damage in the plasma group was lower than that in the laser-plasma and laser groups. No statistically significant difference was identified between the laser-plasma and laser groups ( p = 0.602) (Fig. 5 ). Discussion Laser and bipolar plasma are two of the most commonly utilized energy sources in urologic surgical procedures. Combining laser and plasma into a single, integrated surgical device will undoubtedly streamline their clinical application and optimize the unique advantages of each technology. To date, there are no published report addressing this integration. In the present study, the fabrication of this integrated fiber was demonstrated to be relatively simple and reproducible. Beyond the existing laser and bipolar plasma platforms, this innovation does not require any additional medical instruments. The use of a fine stainless-steel tube ensured the head of the integrated fiber remained very slim. The entire integrated fiber could pass smoothly through the fiber channel of the resectoscope. Developing the electric circuit was challenging in this experiment. The outer sheath of the laser resectoscope was used as part of the electric circuit [ 5 ], and the access point was strategically placed on the knob lock of the resectoscope. This approach was aligned with the circuit design of the Olympus resectoscope. In vitro observations confirmed the safety of this setup. However, additional in vivo verification remains essential. As an electrocautery device, coagulation is a principal function of this dual-functional fiber, so we did not specially verify its coagulating capability. In this experiment, vaporization, rather than resection or vaporesection, was employed to evaluate the biological effectiveness of the integrated fiber on porcine kidneys. It is well recognized that during resection or vaporesection, maintaining precise consistency in the volume of excised tissue is challenging, and this variability can significantly affect the assessment of tissue removal efficiency. In contrast, vaporization is not influenced by this limitation. The combined use of laser and plasma achieved a tissue removal efficiency approximately three to four times that of laser or plasma alone. However, this efficiency remains relatively lower compared to that achieved with thulium laser settings of 70 W and 120 W [ 6 ]. This disparity can likely be attributed to the lower power setting of 50 W used in this study. Indeed, under various conditions, the tissue removal efficiency of lasers is influenced by factors such as tissue size, laser power settings, and the surgeon’s expertise. With regard to thermal damage to kidney tissue, no significant difference was observed between the laser-plasma group and the laser-only group. This finding aligns with previous studies [ 6 , 7 ]. Notably, the plasma group exhibited the shallowest thermal damage compared to the other two groups. It is commonly assumed that the integration of laser energy with plasma results in deeper thermal damage in kidney tissue. However, this assumption was challenged in the present study. Since the plasma-induced thermal damage is minimal and shallow, whereas the laser-induced damage is deeper, the laser emerges as the primary determinant of thermal damage depth. Consequently, the difference in thermal damage observed between the laser-plasma group and the laser group was not statistically significant. In this integrated fiber, the laser and the plasma energy are applied to the kidney tissue within a very short space-time interval. We prefer to call this sequential rather than mixed vaporization by laser and plasma. If this distance is shortened indefinitely, for example, when the tip of the optical fiber is covered by a tiny stainless-steel tube, a mixed energy field of the laser and plasma will be formed. It is important to note that the “plasma” used in this study is not the "plasma" in the physical sense. The so-called "plasma" in bipolar plasma cutting surgery is essentially a partially ionized gaseous medium, primarily composed of ionized particles (such as ions and free electrons) and neutral molecules produced when high-frequency current passes through saline solution. We cannot hope that this laser-plasma interaction will be like a super-pulsed high-energy laser which can even induce plasma and proton acceleration for tumor treatment [ 8 , 9 ]. However, the introduction of high-energy lasers into bipolar plasma resection can theoretically bring the local medium closer to a complete plasma by increasing the ionization degree and temperature [ 10 ]. If the parameters are properly optimized, this composite energy system may provide a new solution with higher precision and lower thermal damage for minimally invasive surgery. Of course, its realization still needs further experimental verification and engineering innovation. This study had some limitations. For a small stainless-steel tube, this was the last resort under our real conditions. After all, we are clinicians, not engineers. Under the current experimental energy level and continuous vaporization mode, the tube could last for up to approximately 5 minutes before self-ablation. Fortunately, the string-like arrangement of the tubes made it easy to cut them off when necessary. If the tube were made of high-temperature-resistant materials, such as tungsten or titanium alloys, the situation would be greatly improved. Additionally, it is necessary to continue to search for insulating materials with good biocompatibility and strong high-temperature resistance to replace the plastic tubes in this study. In summary, a prototype of an integrated dual-functional laser-electric optical fiber was successfully developed. Utilizing this integrated fiber, laser-plasma energy facilitates the vaporization of biological tissues with higher tissue removal efficiency and lower tissue thermal damage. This innovative fiber enables urologists to maximize the benefits of both laser and plasma energy in future urologic surgical procedures. Declarations Data Availability Statement : The data that support the findings of this study are available from the corresponding author upon reasonable request. Funding statement: The authors received no specific funding for this work. Conflicts of Interest: The authors declare no conflicts of interest. Ethics Statement: All procedures performed in this study involving animal participants were in accordance with the ethical standards of the Institutional Animal Ethics Committee of Qishan Hospital (approval no. qsap202305 ) and national research committee [Laboratory animal—Guideline for ethical review of animal welfare（GB/T 35892-2018）]. Consent statement for submission: We confirm that the manuscript has been read and approved by all named authors. We confirm that the order of authors listed in the manuscript has been approved by all of us. All authors unanimously agreed to submit this manuscript to the World Journal of Urology . Acknowledgment ： Thank you to Dr. Mingxia Chen from the Department of Pathology of our hospital. For the histopathological observations involved in this study, Dr. Chen Mingxia gave us careful guidance and help. The corresponding author of this paper would also like to pay tribute to his teacher, Professor Yang Yong, for his long-term concern and guidance in laser urology science research. Authors’ Contributions: Dongchong SUN: Project development, Manuscript writing Yutao ZHANG: Project development, data collection Likun GAI: Data collection, data analysis Chenglin ZHANG: Data collection, data analysis Yanna WANG: Material preparation, Data collection, Hao ZHANG: Data collection, histopathological observations References Porto JG, Bhatia AM, Bhat A et al (2024) Evaluating transurethral resection of the prostate over twenty years: a systematic review and meta-analysis of randomized clinical trials. World J Urol 42:639. https://doi.org/10.1007/s00345-024-05332-3 Bouhadana D, Nguyen DD, Zhang X et al (2021) Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75. World J Urol 39:4405–4412. https://doi.org/10.1007/s00345-021-03779-2 Worthington J, Lane JA, Taylor H et al (2020) Thulium laser transurethral vaporesection versus transurethral resection of the prostate for benign prostatic obstruction: the UNBLOCS RCT. Health Technol Assess 24:1–96. https://doi.org/10.3310/hta24410 Coman RA, Leucuta DC, Coman RT et al (2024) Long-term results of multimodal treatment of the prostate using the Thulium Laser. Med Pharm Rep 97:338–346. https://doi.org/10.15386/mpr-2760 Zeng XT, Jin YH, Liu TZ et al (2021) Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia. Mil Med Res 9:14. https://doi.org/10.1186/s40779-022-00371-6 Bach T, Huck N, Wezel F et al (2010) 70 vs 120 W thulium:yttrium-aluminium-garnet 2 microm continuous-wave laser for the treatment of benign prostatic hyperplasia: a systematic ex-vivo evaluation. BJU Int 106:368–372. https://doi.org/10.1111/j.1464-410X.2009.09059.x Żywicka B, Bujok J, Janeczek M et al (2021) Usefulness of Thulium-Doped Fiber Laser and Diode Laser in Zero Ischemia Kidney Surgery-Comparative Study in Pig Model. Materials (Basel) 14: 2000. https://doi.org/10.3390/ma14082000 Kroll F, Brack FE, Bernert C et al (2022) Tumour irradiation in mice with a laser-accelerated proton beam. Nat Phys 18:316–322. https://doi.org/10.1038/s41567-022-01520-3 Labate L, Palla D, Panetta D et al (2020) Toward an effective use of laser-driven very high energy electrons for radiotherapy: Feasibility assessment of multi-field and intensity modulation irradiation schemes. Sci Rep 10:17307. https://doi.org/10.1038/s41598-020-74256-w Jasiński M (2024) Advances in Plasma and Laser Engineering. Mater (Basel) 17:1768. https://doi.org/10.3390/ma17081768 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6213235","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436023348,"identity":"674d73ad-34a2-4839-94d1-9f8d6230b23e","order_by":0,"name":"Dongchong SUN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYJACCRBhACI+GNjYkaaFcUZBWjJpWph5PhxibCCkXH5G7sEbH3fUypuz9x5+bWNwgJmB/fDRDfi0GNzIS7aceea44c6ec2nWOQZ3+Bh40tJu4NUikWMmzdt2LMHgRo6ZcY7BM2YGCR4zvFrkZyBrsTA4zNhASAvDDbCWGpAW48cMxGgxOPPG2HJm2wHDDWfOmDH2GKQlsxHyi3x7juGNj2118gbHe4w//PhjY8fPfvgYfodBwGEQwQaOIDYilINAHYhg/kCk6lEwCkbBKBhhAACSj0tnqj+/pwAAAABJRU5ErkJggg==","orcid":"","institution":"Qishan Hospital","correspondingAuthor":true,"prefix":"","firstName":"Dongchong","middleName":"","lastName":"SUN","suffix":""},{"id":436023349,"identity":"8f5f54e2-22a1-4db9-bdb4-d8ca2f14c6bb","order_by":1,"name":"Yutao ZHANG","email":"","orcid":"","institution":"Qishan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yutao","middleName":"","lastName":"ZHANG","suffix":""},{"id":436023350,"identity":"fa9d5666-d429-4c50-a4c7-e26c0bdf3459","order_by":2,"name":"Likun GAI","email":"","orcid":"","institution":"Qishan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Likun","middleName":"","lastName":"GAI","suffix":""},{"id":436023351,"identity":"d4116f36-1d62-463a-976b-b3476e992432","order_by":3,"name":"Chenglin ZHANG","email":"","orcid":"","institution":"Qishan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chenglin","middleName":"","lastName":"ZHANG","suffix":""},{"id":436023352,"identity":"75667012-122d-4b48-9f26-76980a678a3d","order_by":4,"name":"Yanna WANG","email":"","orcid":"","institution":"Qishan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanna","middleName":"","lastName":"WANG","suffix":""},{"id":436023353,"identity":"187caf82-84c0-4012-b00b-d9d26e2915c7","order_by":5,"name":"Hao ZHANG","email":"","orcid":"","institution":"Qishan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"ZHANG","suffix":""}],"badges":[],"createdAt":"2025-03-12 15:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6213235/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6213235/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79648098,"identity":"b54b2d87-9db2-4546-8147-55cfe382f886","added_by":"auto","created_at":"2025-04-01 07:24:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75365,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagram of the integrated dual-functional laser-electric optical fiber system.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6213235/v1/30e2b823b0ffbfcae4a4122d.png"},{"id":79648164,"identity":"a97dcb58-2601-47fd-87a4-7a7b8088938c","added_by":"auto","created_at":"2025-04-01 07:24:09","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":163018,"visible":true,"origin":"","legend":"\u003cp\u003eIntegrated dual-functional laser-electric optical fiber.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6213235/v1/4da627f36c70a3ae8621b74b.jpeg"},{"id":79648158,"identity":"2b203061-97c5-4b97-a12e-3eb9a61e2f7c","added_by":"auto","created_at":"2025-04-01 07:24:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":8123,"visible":true,"origin":"","legend":"\u003cp\u003eTissue removal efficiency of the three groups. Significant differences were noted between the laser and laser-plasma groups (\u003cem\u003ep\u003c/em\u003e= 0.000) and between the laser-plasma and plasma groups (\u003cem\u003ep\u003c/em\u003e = 0.000). However, no significant difference was found between the laser and plasma groups (\u003cem\u003ep\u003c/em\u003e = 0.470)\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6213235/v1/926c8b777f83207bd3144aed.png"},{"id":79648156,"identity":"fd2eeb67-1c28-4935-bb58-21732a5bed7d","added_by":"auto","created_at":"2025-04-01 07:24:08","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":281064,"visible":true,"origin":"","legend":"\u003cp\u003eHistopathological observation of thermal damage to the porcine kidney tissue by laser-plasma, laser, and plasma; HE stains. (A) 10×, a large pathological section of porcine kidney tissue after vaporization by the laser-plasma, laser, and plasma energy with the integrated fiber. (B, C, D) 400×, enlarged images of kidney tissue after laser-plasma, laser, and plasma vaporization\u003c/p\u003e","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-6213235/v1/ed8fdc76e4a13b3b071f2de6.png"},{"id":79648165,"identity":"67dd0f24-dca6-4ae0-ae02-08393ba62f9a","added_by":"auto","created_at":"2025-04-01 07:24:09","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":10314,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of thermal damage depth in the three groups. A significant difference was observed among the total groups (F = 52.25, \u003cem\u003ep\u003c/em\u003e = 0.000). The LSD test demonstrated statistically significant differences between the laser-plasma and plasma groups (\u003cem\u003ep\u003c/em\u003e = 0.000) and between the laser and plasma groups (\u003cem\u003ep\u003c/em\u003e = 0.000)\u003c/p\u003e","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-6213235/v1/4ba94c656211f9ac8f4baa0d.png"},{"id":79648858,"identity":"50070efd-ed29-44d3-aa5b-03755ef3714a","added_by":"auto","created_at":"2025-04-01 07:32:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1126350,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6213235/v1/db9bf39f-0d62-4eac-abb0-55d7965f3996.pdf"},{"id":79648155,"identity":"c95dfe13-2c39-4754-a19f-ec818742feda","added_by":"auto","created_at":"2025-04-01 07:24:07","extension":"wmv","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19934185,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1.wmv","url":"https://assets-eu.researchsquare.com/files/rs-6213235/v1/daf1f4019808fc924c33fb6b.wmv"}],"financialInterests":"No competing interests reported.","formattedTitle":"Integrated dual-functional laser-electric optical fiber：A prototype device for urologic surgical procedures","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLasers and electricity are commonly used energy sources in urological surgery. Each has its own advantages and disadvantages. Transurethral resection of the prostate (TURP) remains the historical benchmark surgical treatment for benign prostatic hyperplasia (BPH) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. TURP with bipolar plasma offers better durability but higher complication rates for elderly patients with multiple comorbidities compared to laser prostatectomy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Laser prostatectomy, while advantageous in terms of hemostasis and shorter hospital stays, is less efficient and less cost-effective than TURP [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Consequently, it is challenging for either method to supplant the other.\u003c/p\u003e \u003cp\u003eSome urologists have successfully combined the use of a thulium laser with bipolar TURP for the endoscopic treatment of BPH [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, these methods are applied sequentially rather than truly integrated, making the procedure time-consuming and labor-intensive.\u003c/p\u003e \u003cp\u003eTo address this issue, we hypothesized that integrating laser and electrical energy into a single device could be a viable solution. Therefore, we attempted to incorporate electrical elements into the optical laser fiber to create a surgical tool capable of simultaneous both laser and electrical vaporization/resection for urologic procedures.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePreparation of the Integrated Laser-Electric Fiber\u003c/h2\u003e \u003cp\u003eA commercially available high-energy medical optical fiber (\u003cem\u003eRaykeen, Shanghai, China\u003c/em\u003e), with a diameter of 550 micrometers, and with a stripped outer layer at the distal end, was prepared for integration with the electrical components.\u003c/p\u003e \u003cp\u003eThe electrical components included a fine metal wire and a tiny stainless-steel tube, which were attached to the bare optical fiber and insulated with a plastic tube. Approximately half of the small stainless-steel tube was exposed near its distal end. The proximal end of the fine metal wire was connected to the output of a bipolar plasma generator.\u003c/p\u003e \u003cp\u003eA standard transurethral laser resectoscope (\u003cem\u003eF26, Raykeen, Shanghai, China\u003c/em\u003e) was used in this experiment. The outer sheath of the resectoscope was connected to a plasma generator to serve as part of the electric circuit. The knob lock of the resectoscope served as the access point for the circuit. The integrated fiber was passed through the fiber channel of the resectoscope and connected both to a thulium laser machine and a bipolar plasma generator.\u003c/p\u003e \u003cp\u003eThe final form of this new system is illustrated in the schematic diagram in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVerification of Integrated Laser-Electric Fiber\u003c/h3\u003e\n\u003cp\u003eTo evaluate the functionality of the integrated fiber, a series of simulated transurethral vaporization tests were conducted. Isotonic saline was maintained at room temperature and served as the irrigation fluid. Commercial fresh porcine kidney tissue was utilized as vaporization target. A continuous thulium laser (\u003cem\u003eRaykeen, Shanghai, China\u003c/em\u003e) and a bipolar plasma generator (\u003cem\u003eOlympus, Tokyo, Japan\u003c/em\u003e) were employed in the tests, with energy outputs set at 50 W for the thiulum laser and 100 W/50W (cutting/coagulation mode) for the plasma. The tests were categorized into three groups: laser\u0026ndash;plasma, laser, and plasma group. In the laser\u0026ndash;plasma group, simultaneous activation of the laser and plasma was achieved by depressing both foot switches concurrently.\u003c/p\u003e \u003cp\u003eAll surgical procedures were performed by a single urologist to ensure consistency. During vaporization, the speed of the back-and-forth movement and the downward force applied to the kidney tissue were meticulously maintained at consistent levels. Tissue specimens were collected post-vaporization and fixed in 4% formaldehyde solution. Hematoxylin and Eosin staining was subsequently performed on 5-\u0026micro;m-thick sections for histopathological analysis. The extent of thermal damage in the kidney tissue was examined and quantified.\u003c/p\u003e \u003cp\u003eTissue removal efficiency was assessed using a weighing method. The kidney tissue was weighed before and after vaporization, and the duration of each vaporization procedure was recorded. Tissue removal efficiency (\u003cem\u003eg/min\u003c/em\u003e) was calculated by dividing the change in tissue weight (\u003cem\u003egrams\u003c/em\u003e) by the vaporization time (\u003cem\u003eminutes\u003c/em\u003e).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eOnline software SPSS Pro (available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.spsspro.com\u003c/span\u003e\u003cspan address=\"https://www.spsspro.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e was utilized for statistical analyses. Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Results were analyzed using one-way analysis of variance (ANOVA) followed by the least significant difference (LSD) test. A p-value of \u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eProduct of the integrated dual-functional laser-electric fiber\u003c/h2\u003e \u003cp\u003eAn integrated dual-functional laser-electric optical fiber was successfully developed as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. An electrically conductive wire was securely attached to the fiber and connected to the built-in metal wire inside the integrated fiber, enabling direct connection with the output of the plasma generator. During surgery, any distal segment of the fiber, including the tiny stainless-steel tube, could be cut off if necessary.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eUsability and safety\u003c/h2\u003e \u003cp\u003eDuring all experiments, especially when the bipolar plasma generator was excited, the body of the resectoscope and electric circuit were inspected with an electric pen, and no instances of electric leakage were detected.\u003c/p\u003e \u003cp\u003eThe integrated fiber was manipulated similarly to an ordinary optical fiber in transurethral laser operations. When required, the tiny metal tube was easily maneuvered to a virtual bleeding point for hemostasis in coagulation mode. The surgical view remained clear and was not impaired by any part of the integrated fiber, including the stainless-steel tube at the tip of the fiber. The number of air bubbles generated during vaporization was not significant, and the surgical field visibility was not affected.\u003c/p\u003e \u003cp\u003eThe tiny stainless-steel tube at the integrated fiber tip remained securely in place. When continuously excited under the laser-plasma mode, the stainless-steel tube maintained normal functionality for at least 5 minutes [(5.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34) min]. If substantial self-ablation occurred, the damaged stainless-steel tube could be easily cut off, and the adjacent segment was available for continued use.\u003c/p\u003e \u003cp\u003eThe vaporization procedures could be seen in the supplemental video (\u003cem\u003eSupplement 1\u003c/em\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTissue removal efficiency\u003c/h3\u003e\n\u003cp\u003eMacroscopically, after only one pass of vaporization with the integrated fiber, the vaporized defect caused by the laser-plasma energy was the deepest among the three groups.\u003c/p\u003e \u003cp\u003eThe tissue removal efficiency of the laser-plasma group was significantly greater than that of the plasma group, which demonstrated the lowest efficiency. No significant difference was observed between the laser group and the plasma group (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eThermal damage to the kidney tissue\u003c/h3\u003e\n\u003cp\u003eFor thermal damage to porcine kidney tissue, the carbonized, coagulated, and denatured layer was easily recognized under the microscope (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The degree of thermal damage in the plasma group was lower than that in the laser-plasma and laser groups. No statistically significant difference was identified between the laser-plasma and laser groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.602) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eLaser and bipolar plasma are two of the most commonly utilized energy sources in urologic surgical procedures. Combining laser and plasma into a single, integrated surgical device will undoubtedly streamline their clinical application and optimize the unique advantages of each technology. To date, there are no published report addressing this integration.\u003c/p\u003e \u003cp\u003eIn the present study, the fabrication of this integrated fiber was demonstrated to be relatively simple and reproducible. Beyond the existing laser and bipolar plasma platforms, this innovation does not require any additional medical instruments. The use of a fine stainless-steel tube ensured the head of the integrated fiber remained very slim. The entire integrated fiber could pass smoothly through the fiber channel of the resectoscope.\u003c/p\u003e \u003cp\u003eDeveloping the electric circuit was challenging in this experiment. The outer sheath of the laser resectoscope was used as part of the electric circuit [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and the access point was strategically placed on the knob lock of the resectoscope. This approach was aligned with the circuit design of the Olympus resectoscope. In vitro observations confirmed the safety of this setup. However, additional in vivo verification remains essential.\u003c/p\u003e \u003cp\u003eAs an electrocautery device, coagulation is a principal function of this dual-functional fiber, so we did not specially verify its coagulating capability. In this experiment, vaporization, rather than resection or vaporesection, was employed to evaluate the biological effectiveness of the integrated fiber on porcine kidneys. It is well recognized that during resection or vaporesection, maintaining precise consistency in the volume of excised tissue is challenging, and this variability can significantly affect the assessment of tissue removal efficiency. In contrast, vaporization is not influenced by this limitation.\u003c/p\u003e \u003cp\u003eThe combined use of laser and plasma achieved a tissue removal efficiency approximately three to four times that of laser or plasma alone. However, this efficiency remains relatively lower compared to that achieved with thulium laser settings of 70 W and 120 W [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This disparity can likely be attributed to the lower power setting of 50 W used in this study. Indeed, under various conditions, the tissue removal efficiency of lasers is influenced by factors such as tissue size, laser power settings, and the surgeon\u0026rsquo;s expertise.\u003c/p\u003e \u003cp\u003eWith regard to thermal damage to kidney tissue, no significant difference was observed between the laser-plasma group and the laser-only group. This finding aligns with previous studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Notably, the plasma group exhibited the shallowest thermal damage compared to the other two groups.\u003c/p\u003e \u003cp\u003eIt is commonly assumed that the integration of laser energy with plasma results in deeper thermal damage in kidney tissue. However, this assumption was challenged in the present study. Since the plasma-induced thermal damage is minimal and shallow, whereas the laser-induced damage is deeper, the laser emerges as the primary determinant of thermal damage depth. Consequently, the difference in thermal damage observed between the laser-plasma group and the laser group was not statistically significant.\u003c/p\u003e \u003cp\u003eIn this integrated fiber, the laser and the plasma energy are applied to the kidney tissue within a very short space-time interval. We prefer to call this sequential rather than mixed vaporization by laser and plasma. If this distance is shortened indefinitely, for example, when the tip of the optical fiber is covered by a tiny stainless-steel tube, a mixed energy field of the laser and plasma will be formed.\u003c/p\u003e \u003cp\u003eIt is important to note that the \u0026ldquo;plasma\u0026rdquo; used in this study is not the \"plasma\" in the physical sense. The so-called \"plasma\" in bipolar plasma cutting surgery is essentially a partially ionized gaseous medium, primarily composed of ionized particles (such as ions and free electrons) and neutral molecules produced when high-frequency current passes through saline solution. We cannot hope that this laser-plasma interaction will be like a super-pulsed high-energy laser which can even induce plasma and proton acceleration for tumor treatment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the introduction of high-energy lasers into bipolar plasma resection can theoretically bring the local medium closer to a complete plasma by increasing the ionization degree and temperature [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. If the parameters are properly optimized, this composite energy system may provide a new solution with higher precision and lower thermal damage for minimally invasive surgery. Of course, its realization still needs further experimental verification and engineering innovation.\u003c/p\u003e \u003cp\u003eThis study had some limitations. For a small stainless-steel tube, this was the last resort under our real conditions. After all, we are clinicians, not engineers. Under the current experimental energy level and continuous vaporization mode, the tube could last for up to approximately 5 minutes before self-ablation. Fortunately, the string-like arrangement of the tubes made it easy to cut them off when necessary. If the tube were made of high-temperature-resistant materials, such as tungsten or titanium alloys, the situation would be greatly improved. Additionally, it is necessary to continue to search for insulating materials with good biocompatibility and strong high-temperature resistance to replace the plastic tubes in this study.\u003c/p\u003e \u003cp\u003eIn summary, a prototype of an integrated dual-functional laser-electric optical fiber was successfully developed. Utilizing this integrated fiber, laser-plasma energy facilitates the vaporization of biological tissues with higher tissue removal efficiency and lower tissue thermal damage. This innovative fiber enables urologists to maximize the benefits of both laser and plasma energy in future urologic surgical procedures.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e: The data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u0026nbsp;\u003c/strong\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement:\u003c/strong\u003e All procedures performed in this study involving animal participants were in accordance with the ethical standards of the Institutional Animal Ethics Committee of Qishan Hospital (approval no.\u003cem\u003eqsap202305\u003c/em\u003e) and national research committee [Laboratory animal\u0026mdash;Guideline for ethical review of animal welfare（GB/T 35892-2018）].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent statement for submission:\u003c/strong\u003e We confirm that the manuscript has been read and approved by all named authors. We confirm that the order of authors listed in the manuscript has been approved by all of us. All authors unanimously agreed to submit this manuscript to \u003cem\u003ethe World Journal of Urology\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThank you to Dr. Mingxia Chen from the Department of Pathology of our hospital. For the histopathological observations involved in this study, Dr. Chen Mingxia gave us careful guidance and help. The corresponding author of this paper would also like to pay tribute to his teacher, Professor Yang Yong, for his long-term concern and guidance in laser urology science research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDongchong SUN: Project development, Manuscript writing\u003c/p\u003e\n\u003cp\u003eYutao ZHANG: Project development, data collection\u003c/p\u003e\n\u003cp\u003eLikun GAI: Data collection, data analysis\u003c/p\u003e\n\u003cp\u003eChenglin ZHANG: Data collection, data analysis\u003c/p\u003e\n\u003cp\u003eYanna WANG: Material preparation, Data collection,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHao ZHANG: Data collection, histopathological observations\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePorto JG, Bhatia AM, Bhat A et al (2024) Evaluating transurethral resection of the prostate over twenty years: a systematic review and meta-analysis of randomized clinical trials. World J Urol 42:639. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00345-024-05332-3\u003c/span\u003e\u003cspan address=\"10.1007/s00345-024-05332-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouhadana D, Nguyen DD, Zhang X et al (2021) Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;75. World J Urol 39:4405\u0026ndash;4412. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00345-021-03779-2\u003c/span\u003e\u003cspan address=\"10.1007/s00345-021-03779-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorthington J, Lane JA, Taylor H et al (2020) Thulium laser transurethral vaporesection versus transurethral resection of the prostate for benign prostatic obstruction: the UNBLOCS RCT. Health Technol Assess 24:1\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3310/hta24410\u003c/span\u003e\u003cspan address=\"10.3310/hta24410\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eComan RA, Leucuta DC, Coman RT et al (2024) Long-term results of multimodal treatment of the prostate using the Thulium Laser. Med Pharm Rep 97:338\u0026ndash;346. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.15386/mpr-2760\u003c/span\u003e\u003cspan address=\"10.15386/mpr-2760\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeng XT, Jin YH, Liu TZ et al (2021) Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia. Mil Med Res 9:14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40779-022-00371-6\u003c/span\u003e\u003cspan address=\"10.1186/s40779-022-00371-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBach T, Huck N, Wezel F et al (2010) 70 vs 120 W thulium:yttrium-aluminium-garnet 2 microm continuous-wave laser for the treatment of benign prostatic hyperplasia: a systematic ex-vivo evaluation. BJU Int 106:368\u0026ndash;372. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1464-410X.2009.09059.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1464-410X.2009.09059.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŻywicka B, Bujok J, Janeczek M et al (2021) Usefulness of Thulium-Doped Fiber Laser and Diode Laser in Zero Ischemia Kidney Surgery-Comparative Study in Pig Model. \u003cem\u003eMaterials (Basel)\u003c/em\u003e 14: 2000. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ma14082000\u003c/span\u003e\u003cspan address=\"10.3390/ma14082000\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKroll F, Brack FE, Bernert C et al (2022) Tumour irradiation in mice with a laser-accelerated proton beam. Nat Phys 18:316\u0026ndash;322. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41567-022-01520-3\u003c/span\u003e\u003cspan address=\"10.1038/s41567-022-01520-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabate L, Palla D, Panetta D et al (2020) Toward an effective use of laser-driven very high energy electrons for radiotherapy: Feasibility assessment of multi-field and intensity modulation irradiation schemes. Sci Rep 10:17307. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-020-74256-w\u003c/span\u003e\u003cspan address=\"10.1038/s41598-020-74256-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJasiński M (2024) Advances in Plasma and Laser Engineering. Mater (Basel) 17:1768. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ma17081768\u003c/span\u003e\u003cspan address=\"10.3390/ma17081768\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"laser, electrosurgery, integration, vaporization, urologic surgical procedures","lastPublishedDoi":"10.21203/rs.3.rs-6213235/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6213235/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eWe introduce an integrated optical fiber that can simultaneously transmit high-power laser energy and conduct electricity for urologic surgical procedures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn integrated dual-functional laser\u0026ndash;electric optical fiber was successfully developed based on a widely used medical high-energy optical fiber, modified with electrical components. This fiber can connect with a thulium laser and a bipolar plasma generator simultaneously. Using the fiber, an ex vivo simulation of transurethral vaporization of porcine kidney tissues was conducted in three groups (laser-plasma, laser, and plasma). Tissue removal efficiency was calculated using the weighing method, and tissue thermal damage was assessed by Hematoxylin and Eosin (H\u0026amp;E) staining. One-way analysis of variance (ANOVA) and least significant difference (LSD) test were used for statistical analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe integrated fiber is compatible with the laser resectoscope. In terms of tissue removal efficiency, the laser-plasma group had the highest [(0.433\u0026thinsp;\u0026plusmn;\u0026thinsp;0.039) g/min] and the plasma group had the lowest, while there was no significant difference between the laser and plasma groups [(0.141\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017) vs (0.117\u0026thinsp;\u0026plusmn;\u0026thinsp;0.052) g/min, p\u0026thinsp;=\u0026thinsp;0.470]. For thermal damage, there was no significant difference between the laser-plasma and laser groups [(985.484\u0026thinsp;\u0026plusmn;\u0026thinsp;178.509) vs (957.511\u0026thinsp;\u0026plusmn;\u0026thinsp;197.375) \u0026micro;m, p\u0026thinsp;=\u0026thinsp;0.602], but both were significantly higher than those in the plasma group [(499.639\u0026thinsp;\u0026plusmn;\u0026thinsp;77.992) \u0026micro;m].\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eA prototype of an integrated dual-functional laser-electric optical fiber was successfully developed. Compared with the laser or the plasma energy alone, the combined laser-plasma energy can vaporize kidney tissue more efficiently without additional thermal damage.\u003c/p\u003e","manuscriptTitle":"Integrated dual-functional laser-electric optical fiber：A prototype device for urologic surgical procedures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 07:23:56","doi":"10.21203/rs.3.rs-6213235/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9746dff6-28e4-4b1b-a22a-00714ef19551","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-01T11:08:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 07:23:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6213235","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6213235","identity":"rs-6213235","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}